The Effect of Perioperative Intravenous Lidocaine on Postoperative Pain and Immune Function
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BACKGROUND: Surgery-associated tissue injury leads to nociception and inflammatory reaction, accompanied by increased production of proinflammatory cytokines. These cytokines can induce peripheral and central sensitization, leading to pain augmentation. Recently, a frequently used local anesthetic, lidocaine, was introduced as a part of a perioperative pain management technique. In addition to its analgesic effects, lidocaine has an antiinflammatory property, decreasing the upregulation of proinflammatory cytokines. We focused on the effects of preincisional and intraoperative IV lidocaine on pain intensity and immune reactivity in the postoperative period. METHODS: Sixty-five female patients (ASA physical status I–II) scheduled for transabdominal hysterectomy were recruited to this randomized, placebo-controlled study. Thirty-two patients in the treatment group received IV lidocaine starting 20 min before surgery, whereas the control group (33 patients) received a matched saline infusion. Both groups received patient-controlled epidural analgesia during the postoperative period. Blood samples were collected before, 24, 48, and 72 h after surgery to measure ex vivo cytokine production of interleukin (IL)-1 receptor antagonist (IL-1ra) and IL-6, as well lymphocyte mitogenic response to phytohemagglutinin-M. A 10-cm visual analog scale was used to assess pain intensity at rest and after coughing. RESULTS: Patients in the lidocaine + patient-controlled epidural analgesia group experienced less severe postoperative pain in the first 4 and 8 h after surgery (visual analog scale 4/3.7 at rest and 5.3/5 during coughing versus 4.5/4.2 and 6.1/5.3, respectively, in the placebo group). There was significantly less ex vivo production of IL-1ra and IL-6, whereas the lymphocyte proliferation response to phytohemagglutinin-M was better maintained than in the control group. CONCLUSION: The present findings indicate that preoperative and intraoperative IV lidocaine improves immediate postoperative pain management and reduces surgery-induced immune alterations.Keywords:
Proinflammatory cytokine
Background: Lidocaine injection for local anesthesia is a common podiatric medical procedure. We tested the hypothesis that injection of bacteriostatic saline solution containing 0.9% benzyl alcohol before the lidocaine infiltration can reduce the burning caused by lidocaine injection. Methods: This double-blind prospective trial involved 45 participants who each received four injections in two areas of the dorsum of the foot and rated the perceived pain on a visual analog scale. The order of the injections was designed to disguise the control and intervention arms of the study. Results: The sensation of the lidocaine injection after the injection of saline was reduced significantly (P = .028). The percentage of lidocaine injections with visual analog scale scores of 0 increased by 36% after preinjection with bacteriostatic saline solution containing 0.9% benzyl alcohol. Conclusions: The fact that 40% of the intervention visual analog scale pain scores for lidocaine injections were 0 suggests that a near painless lidocaine injection technique is an achievable goal and that the present technique is a simple and inexpensive method of reducing the pain of lidocaine injections. (J Am Podiatr Med Assoc 101(3): 223–230, 2011)
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Infiltration (HVAC)
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Abstract Previous reports have suggested that pain associated with the injection of lidocaine is related to the acidic pH of the solution. To determine if the addition of a buffering solution to adjust the pH of lidocaine into the physiologic range would reduce pain during injection, we performed a blinded randomized study in patients undergoing cardiac catheterization. Twenty patients were asked to quantify the severity of pain after receiving standard lidocaine in one femoral area and buffered lidocaine in the opposite femoral area. The mean pain score for buffered lidocaine was significantly lower than the mean score for standard lidocaine (2.7 ± 1.9 vs. 3.8 ± 2.2, P =0.03). The pH adjustment of standard lidocaine can be accomplished easily in the catheterization laboratory before injection and results in a reduction of the pain occuring during the infiltration of tissues.
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________________________________________________________________________________________ LEMO, N., D. VNUK, F. BANOVIC: Observation of potential lidocaine toxicity during local anesthesia administration for punch skin biopsy in dogs. Vet. arhiv 85, 523-532, 2015. ABSTRACT Punch biopsies are a widely used diagnostic method in veterinary dermatology. During a biopsy, it is necessary to use local anesthesia and/or sedation to prevent pain. Lidocaine is a local analgesic drug that is often used. Adding adrenaline to lidocaine solutions for local anesthesia potentiates and prolongs its analgesic action. Intravenous lidocaine administration has been reported to cause signifi cant side effects, seizures being considered the most common sign of intoxication, while bradyarrhythmia and conduction disturbances are less prevalent. The aim of this study is to investigate the potential lidocaine toxicity effect of two frequently used local anesthetic solutions, lidocaine and lidocaine/adrenaline combination. Nine healthy dogs were randomly assigned into two groups. One group (n = 4) received subcutaneous injections of lidocaine (total of six 1 mL injections of 2 % lidocaine solution), while the dogs in the second group (n = 5) received a lidocaine/adrenaline combination (total of six 1 mL injections of 2 % lidocaine solution plus 0.0125 mg adrenaline tartarate). None of the known lidocaine side effects were observed. The blood concentration of lidocaine was far below the reported convulsive threshold in dogs. Subcutaneous administration of two different lidocaine local anesthetic formulations was shown to be well tolerated and safe. This research suggests that lidocaine and lidocaine/ adrenaline formulation can be safely used as a local anesthetic for skin punch biopsies in dogs with body mass greater than 5 kg.
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In Brief BACKGROUND: The addition of clonidine to local anesthesia prolongs the local anesthetic action, but in humans, the contribution of a peripheral mechanism remains unclear. METHODS: We investigated clonidine's peripheral effect in 20 healthy volunteers undergoing double-blind, subcutaneous infiltration of 0.5% lidocaine with normal saline to one forearm and then, immediately, of lidocaine with 10 μg clonidine to the contralateral arm. Pinprick sensation was tested every 15 min for 6 h. RESULTS: Median time to return of normal sensation was 3.5 h for lidocaine alone, but at least 6 h if combined with clonidine (P < 0.001). CONCLUSIONS: Clonidine has a significant peripheral action in enhancing duration of local anesthesia on superficial co-infiltration with lidocaine. IMPLICATIONS: Clonidine prolongs anesthesia from superficial lidocaine infiltration by a peripheral mechanism.
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Mepivacaine
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Background During peripheral nerve block, local anesthetic (LA) penetrates within and along the nerve to produce the observed functional deficits. Although much is known about the kinetics and steady-state relation for LA inhibition of impulse activity in vitro in isolated nerve, little is known about the relation between functional loss and intraneural LA content in vivo. This study was undertaken to investigate the relation of functional change to intraneural LA. Methods A sciatic nerve block was performed in rats with 0.1 ml 1% lidocaine radiolabeled with 14C. The total intraneural uptake of LA was determined at different times after injection, and the distribution of lidocaine along the nerve was assayed at different stages of functional block. Drug content was also compared with equilibrium lidocaine uptake in the isolated rat sciatic nerve. Results Total intraneural lidocaine in vivo increased to near steady-state in about 3 min, stabilizing at approximately 14.3 nmol/mg wet tissue for about 12 min before decreasing to zero at 70 min after injection. Although intraneural lidocaine was 1.6% of the injected dose during full block, only 0.3% was left when deep pain sensation returned and 0.065% was still detected when functions fully recovered. Despite these large differences in total lidocaine content, the longitudinal distribution remained constant. Intraneural lidocaine concentrations obtained at full block and partial recovery could be achieved in vitro by equilibration in 0.7-0.9 and 0.2-0.3 mM lidocaine, respectively. Conclusions During peripheral nerve block only a small amount of injected LA penetrates into the nerve. The intraneural content of LA correlates with the depth of functional block.
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Despite current clinical practice, there is no objective evidence to demonstrate the efficacy or pain on injection when hyaluronidase is added to lidocaine as an anesthetic combination for local anesthesia. To evaluate the usefulness of hyaluronidase added to lidocaine in affecting pain on injection and effectiveness of local anesthesia, a prospective, randomized, double blind study comparing 1% lidocaine preparations with and without hyaluronidase (15 U/cc) was conducted. A paired experiment was done with each subject receiving both treatments. Solutions of these local anesthetics were prepared. A 0.5-cc intradermal injection of each was administered to the dorsum of the nondominant hand of 25 volunteers. After showing study participants a standard pain with a peripheral nerve stimulator, pain of anesthetic infiltration was rated by the subject using a visual analog scale. The amount of tissue deformation on injection was assessed. The area of anesthetized skin surrounding each injection was measured at ½, 1, 2½, 4½, 8, and 12 minutes after injection. The area of anesthesia achieved by 1% lidocaine infiltration can be significantly enhanced by the addition of hyaluronidase at a concentration of 15 U/cc (p = 0.0003). This raises the pH of the anesthetic to a slightly more physiologic level (6.33 versus 6.20) and makes the pH closer to the pK of the lidocaine. In addition, the hyaluronidase additive significantly decreases the amount of tissue distortion (p < 0.0001) without decreasing the efficacy of anesthetic action (p = 0.01). However, adding hyaluronidase to 1% lidocaine significantly increased the pain on injection (p = 0.0002). The injections of small amounts of hyaluronidase-containing solutions in this experiment did not produce any visible effects at 5 to 7 days after injection; however, the effect of hyaluronidase upon wound healing was not studied. (Plast. Reconstr. Surg. 100: 365, 1998.)
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Objective: To evaluate the efficacy of a less invasive method of administering local anesthesia (10% lidocaine packing) against the lidocaine local injection for pain control in myringotomy procedures. Materials and Methods: The present study was a prospective, randomized controlled trial. Two local anesthetic procedures were randomly assigned to patients aged over 18 years who required a myringotomy. The patients were given either a 10% lidocaine-soaked cotton packing or a 2% lidocaine local injection. Pain scores during the anesthetic procedures, during the myringotomy procedure, and immediately following the myringotomy procedure were evaluated and compared between both groups. Results: There were 20 patients who participated in this study, with 10 patients in each treatment arm. Baseline characteristics of patients in both groups were comparable. The 10% lidocaine packing group had significantly lowered pain score during the anesthetic procedure than did the 2% lidocaine group (0 vs. 7; p-value <0.001). There was no statistical difference in the other two pain scores between the two groups. Conclusion: The 10% lidocaine packing method is a better method than the 2% lidocaine injection for anesthesia during myringotomy in terms of causing less pain during the anesthetic procedure. Keywords: Anesthesia, Lidocaine, Local, Myringotomy, Topical
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